Bird Flu Movie: More Fact or Fiction?

A deadly bird flu is devastating the world -- but only in a made-for-TV movie.

ABC's Fatal Contact: Bird Flu in America, which aired Tuesday night, was fiction. It presented a worst-of-worst-cases scenario of what might happen in a pandemic of deadly, highly contagious bird flu.

Could what happened in the movie really take place? Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, was a script consultant for the movie (at her request, her name does not appear in the movie credits).

Garrett, a Pulitzer-Prize-winning journalist, is author of "The Coming Plague" and "Betrayal of Trust." The first book warns that world conditions are ripe for the emergence of deadly new diseases. The second warns that global public health is in a state of decline.

"The film is very grim. But I don't think it is sensationalistic," Garrett told WebMD. "I didn't think they exaggerated, but it is a worst-case scenario. A virulent, highly contagious flu comes to America. There is no viable vaccine on tap. The drugs have limited or no efficacy. There are shortages of essential supplies and goods that become acute later in the epidemic."

So what about the movie is realistic, and what is not? First, some basic facts:

--There is no bird flu epidemic in humans anywhere in the world.

--H5N1 bird flu virus -- the strain that has killed more than 160 people, mostly in Asia -- cannot easily spread from person to person. Human infections can be deadly. But in nearly all cases people caught the virus after close contact with infected chickens or ducks. The very few cases of suspected human-to-human transmission came after extended, close personal contact.

--Flu pandemics aren't always plagues. The 1957 and 1968 flu pandemics were a lot like a particularly bad flu season.

--While the H5N1 bird flu virus is very deadly, it might act very differently if it were to become a pandemic virus. That is, the virus would have to change in order to spread among humans. Those changes may make it far less deadly than the version that now spreads in birds.

In the movie, migrating birds spread the flu virus. In real life, migrating birds do seem to spread the disease among other birds. But many experts think it's the international trade in poultry -- not wild birds -- that spreads the virus.

In the movie, the arrival of infected wild birds is a harbinger of doom. In real life, migrating birds carry all sorts of flu viruses. If wild birds carrying H5N1 bird flu show up in the U.S. -- and many think that's inevitable -- it does not signal the start of a human epidemic.

Realistic Quarantines?

In the movie, quarantines shut whole neighborhoods off from the world. In real life, modern quarantines are usually voluntary. The idea is to keep people who have been exposed to a disease -- but who aren't yet ill -- from spreading the disease. For example, foreign travelers or people exposed at a public gathering may be quarantined. This is done by asking exposed individuals to remain in their homes or at community facilities. But in extreme cases, entire communities might be closed.

Quarantine is useful only in the earliest stages of an epidemic, when there is still the chance that a virus can be contained. Once there's an epidemic, "social distancing" is more effective. This means closing schools, asking people to avoid public gatherings, and asking people who feel sick to stay at home.

In the movie, health care workers wear flimsy masks for protection. In real life, health care workers use what are known as N95 respirators when treating bird flu patients. N95 dust masks may offer protection. In the event of a bird flu pandemic, they will be widely used. But there's no proof they would really protect people from infection. Even if they did, proper use would be a problem for most people.

In the movie, there was at first no bird flu vaccine. It later turns out there is a French prototype vaccine that may or may not work. Only international sanctions force France to share the formula. In real life, there are prototype bird flu vaccines that may or may not work. Like the movie, in a real pandemic situation countries are unlikely to share drug and vaccine stockpiles if their own nation is in need -- but withholding basic scientific information is unlikely.

Current bird-flu prototype vaccines take two large doses, weeks apart, to stimulate immunity -- clearly no magic bullet to stop a flu pandemic. However, the government is stockpiling prototype vaccines, which may offer some protection to a limited number of health care workers and other critically important workers. In both the movie and real life, it would take at least six months before current technology could start producing a vaccine tailored to the pandemic strain.

Supply Shortages

In the movie, essential services, electricity, food, and water became scarce. In a real-life pandemic of a very bad flu virus, this could happen when large numbers of people get sick at the same time. Hospitals, too, would be overwhelmed. The U.S. government recommends that people stockpile basic necessities in the event of an emergency.

In the movie, people died because they couldn't get medicines such as insulin. In a severe, real-life pandemic, medical supplies will be hard to get. Pandemic preparedness planning includes seeing your doctor to ensure an adequate supply of essential medicines.

In the movie, there weren't enough antiflu medicines to go around -- and the drugs soon stopped working. In real life, the U.S. is stockpiling enough flu drugs to treat a quarter of the population. That's how many people got sick in past flu pandemics. The U.S. currently has 26 million treatment courses and expects to have 81 million by the end of 2008. While the bird flu virus can become resistant to the flu drug Tamiflu, there's no evidence that Tamiflu-resistant virus is being spread.

Body Disposal

In the movie, dump trucks disposed of dead bodies in mass graves. In real life, a major U.S. government priority is to prepare for disposal of large numbers of bodies in the event of a worst-case pandemic. That planning is not yet complete. However, the U.S. Department of Health and Human Services says that "it is highly unlikely that in the 21st century in the U.S. that we would ever resort to mass graves."

In the movie, at the very end, the pandemic's second wave appeared to be 100 percent lethal. In real life, pandemics do come in waves -- but it's extremely unlikely that the H5N1 bird flu could become as deadly as the movie virus.

However, in the 1918 flu pandemic, the second wave was worse than the first. And H5N1 bird flu is a very bad flu virus. There's no guarantee that a pandemic version of this virus would be less virulent.

Garrett noted that people have warned for years that the New Orleans levees would not stand up to a major hurricane. Yet nobody ever got around to doing anything about it. Maybe, Garrett said, a scary movie is just what we need to spur pandemic preparedness.

"It ought not be necessary to scare the bejeezus out of us to get us to build levees for public health," Garrett said. "